RNC NIC |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A large ventricular septal defect (VSD) may not be immediately evident at birth due to:
A. elevated pulmonary vascular resistance.
B. patency of the ductus venosus.
C. patent ductus arteriosus that prevents flow through the VSD.
D. decreased pulmonary vascular resistance.
CORRECT ANSWER
A. Large ventral septal defects are not symptomatic at birth because the pulmonary
vascular resistance is normally elevated at this time. As the pulmonary vascular
resistance decreases over the first 6-8 weeks of life, the amount of shunted blood
increases and symptoms may develop. The ductus venosus converts to a ligament with
removal of the placental circuit at birth. A patent ductus arteriosus is the connection
between the pulmonary artery and the aorta in utero rather than the ventricles.
Question 2
In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by
which of the following?
A. Degree of pulmonary edema
B. Size of the ventricular septal defect
C. Degree of right ventricular outflow obstruction
D. Size of the patent ductus arteriosus
CORRECT ANSWER
C. The presence of an obstruction to right ventricular (RV) outflow with a large ventral
septal defect causes a right-to-left shunt at the ventricular level with arterial
desaturation. The greater the obstruction and the lower the systemic vascular resistance,
1
, the greater the right-to-left shunt. Thus the clinical findings vary with the degrees of RV
outflow obstruction. Patients with mild obstruction are minimally cyanotic or acyanotic.
Those with severe obstruction are most likely to be deeply cyanotic from birth. Few
children are asymptomatic. In those with significant RV outflow obstruction, many have
cyanosis at birth and nearly all have cyanosis by age 4 months. A patent ductus is the
connection between the pulmonary artery and aorta in utero and does not involve the
cardiac septum. Pulmonary edema is a common occurrence in infants with congestive
heart failure.
Question 3
A 500g infant with a patent ductus arteriosus is being treated with indomethacin. When
formulating a plan of care, the nurse should monitor which of the following parameters?
A. Urinary output
B. Blood pressure and pulses
C. Liver enzymes and bilirubin levels
D. Activity level and state of arousal
CORRECT ANSWER
A. Indomethacin is an inhibitor of prostaglandin synthesis. Most notably, it decreases
blood flow to the renal system, thus decreasing renal perfusion and urinary output. If
oliguria occurs, electrolytes should be monitored and renally excreted drugs should be
adjusted appropriately. Gastrointestinal perfusion may also be decreased, but generally
not to the extent of renal function.
Question 4
An infant presents with cyanosis at birth and is later diagnosed with transposition of the
great vessels per echocardiography. The nurse recognizes that the degree of cyanosis
depends on which of the following factors?
A. Volume of cardiac output
B. Amount of obstruction to the pulmonary circuit
C. Quantity of pulmonary edema
2
,D. Volume of mixing between pulmonary and systemic circulations
CORRECT ANSWER
D. In transposition of the great vessels, the degree of cyanosis depends on the amount of
mixing between the pulmonary and systemic circulations. Oxygenated pulmonary venous
blood is returned to the lungs and desaturated systemic blood is returned to the body.
Thus the two circulations exist in parallel. Some mixing between them must occur to
allow oxygenated blood to reach the systemic circulation and the desaturated blood to
reach the lungs. Pulmonary edema, cardiac output, and obstruction to the pulmonary
circuit do not affect the degree of cyanosis and/or mixing of the pulmonary and systemic
circulations.
Question 5
A balloon septostomy is done for an infant with transposition of the great vessels to
achieve which of the following?
A. Increase pulmonary and systemic mixing at the atrial level
B. Increase cardiac output by creating a ventricular septal defect
C. Decrease pulmonary and systemic mixing at the ventricular level
D. Create a parallel circulation between the venous and arterial circuits
CORRECT ANSWER
A. When an infant has a restrictive atrial septal defect (ASD), a balloon atrial septostomy,
a technique developed by William Rashkind in 1966, may be performed.
The procedure involves inserting a balloon-tipped catheter across the foramen ovale into
the left atrium. The balloon is then inflated and forcibly withdrawn so that the catheter
tears the septum primum and enlarges the ASD. Mixing should increase immediately,
with a corresponding increase in arterial oxygen saturation. The ventricular septal defect
is a connection between the right and left ventricles and is not the site of the balloon
septostomy. Parallel circuits do not allow for the mixing of blood flow.
Question 6
3
, While performing a pulse oximetry screening on an infant nearing discharge a nurse notes
a differential of 2% between preductal and postductal readings. The nurse should do
which of the following?
A. Notify the neonatologist immediately
B. Consider this a negative screen
C. Retest in 1 hour
D. Instruct the family to schedule a repeat test after discharge
CORRECT ANSWER
B. A screen result would be considered positive if any oxygen saturation measures less
than 90%, oxygen saturation is less than 95% in both extremities on three measures -
each separated by 1 hour, or there is a 3% absolute difference in oxygen saturation
between the right hand and foot on three measures, each separated by 1 hour. Any
screening that is >95% in either extremity with no more than a 3% absolute difference in
oxygen saturation between the upper and lower extremity would be considered a "pass"
result and screening would end.
Question 7
The nurse should utilize which of the following parameters to select the appropriate sized
blood pressure cuff?
A. 25% greater than the width of the extremity
B. 50% greater than the width of the extremity
C. The same width as the extremity
D. 75% greater than the width of the extremity
CORRECT ANSWER
A. The cuff width should be 25% greater than the width of the extremity. The blood
pressure reading will be falsely elevated if the cuff is too narrow and falsely low if the
cuff is too large.
Question 8
4
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A large ventricular septal defect (VSD) may not be immediately evident at birth due to:
A. elevated pulmonary vascular resistance.
B. patency of the ductus venosus.
C. patent ductus arteriosus that prevents flow through the VSD.
D. decreased pulmonary vascular resistance.
CORRECT ANSWER
A. Large ventral septal defects are not symptomatic at birth because the pulmonary
vascular resistance is normally elevated at this time. As the pulmonary vascular
resistance decreases over the first 6-8 weeks of life, the amount of shunted blood
increases and symptoms may develop. The ductus venosus converts to a ligament with
removal of the placental circuit at birth. A patent ductus arteriosus is the connection
between the pulmonary artery and the aorta in utero rather than the ventricles.
Question 2
In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by
which of the following?
A. Degree of pulmonary edema
B. Size of the ventricular septal defect
C. Degree of right ventricular outflow obstruction
D. Size of the patent ductus arteriosus
CORRECT ANSWER
C. The presence of an obstruction to right ventricular (RV) outflow with a large ventral
septal defect causes a right-to-left shunt at the ventricular level with arterial
desaturation. The greater the obstruction and the lower the systemic vascular resistance,
1
, the greater the right-to-left shunt. Thus the clinical findings vary with the degrees of RV
outflow obstruction. Patients with mild obstruction are minimally cyanotic or acyanotic.
Those with severe obstruction are most likely to be deeply cyanotic from birth. Few
children are asymptomatic. In those with significant RV outflow obstruction, many have
cyanosis at birth and nearly all have cyanosis by age 4 months. A patent ductus is the
connection between the pulmonary artery and aorta in utero and does not involve the
cardiac septum. Pulmonary edema is a common occurrence in infants with congestive
heart failure.
Question 3
A 500g infant with a patent ductus arteriosus is being treated with indomethacin. When
formulating a plan of care, the nurse should monitor which of the following parameters?
A. Urinary output
B. Blood pressure and pulses
C. Liver enzymes and bilirubin levels
D. Activity level and state of arousal
CORRECT ANSWER
A. Indomethacin is an inhibitor of prostaglandin synthesis. Most notably, it decreases
blood flow to the renal system, thus decreasing renal perfusion and urinary output. If
oliguria occurs, electrolytes should be monitored and renally excreted drugs should be
adjusted appropriately. Gastrointestinal perfusion may also be decreased, but generally
not to the extent of renal function.
Question 4
An infant presents with cyanosis at birth and is later diagnosed with transposition of the
great vessels per echocardiography. The nurse recognizes that the degree of cyanosis
depends on which of the following factors?
A. Volume of cardiac output
B. Amount of obstruction to the pulmonary circuit
C. Quantity of pulmonary edema
2
,D. Volume of mixing between pulmonary and systemic circulations
CORRECT ANSWER
D. In transposition of the great vessels, the degree of cyanosis depends on the amount of
mixing between the pulmonary and systemic circulations. Oxygenated pulmonary venous
blood is returned to the lungs and desaturated systemic blood is returned to the body.
Thus the two circulations exist in parallel. Some mixing between them must occur to
allow oxygenated blood to reach the systemic circulation and the desaturated blood to
reach the lungs. Pulmonary edema, cardiac output, and obstruction to the pulmonary
circuit do not affect the degree of cyanosis and/or mixing of the pulmonary and systemic
circulations.
Question 5
A balloon septostomy is done for an infant with transposition of the great vessels to
achieve which of the following?
A. Increase pulmonary and systemic mixing at the atrial level
B. Increase cardiac output by creating a ventricular septal defect
C. Decrease pulmonary and systemic mixing at the ventricular level
D. Create a parallel circulation between the venous and arterial circuits
CORRECT ANSWER
A. When an infant has a restrictive atrial septal defect (ASD), a balloon atrial septostomy,
a technique developed by William Rashkind in 1966, may be performed.
The procedure involves inserting a balloon-tipped catheter across the foramen ovale into
the left atrium. The balloon is then inflated and forcibly withdrawn so that the catheter
tears the septum primum and enlarges the ASD. Mixing should increase immediately,
with a corresponding increase in arterial oxygen saturation. The ventricular septal defect
is a connection between the right and left ventricles and is not the site of the balloon
septostomy. Parallel circuits do not allow for the mixing of blood flow.
Question 6
3
, While performing a pulse oximetry screening on an infant nearing discharge a nurse notes
a differential of 2% between preductal and postductal readings. The nurse should do
which of the following?
A. Notify the neonatologist immediately
B. Consider this a negative screen
C. Retest in 1 hour
D. Instruct the family to schedule a repeat test after discharge
CORRECT ANSWER
B. A screen result would be considered positive if any oxygen saturation measures less
than 90%, oxygen saturation is less than 95% in both extremities on three measures -
each separated by 1 hour, or there is a 3% absolute difference in oxygen saturation
between the right hand and foot on three measures, each separated by 1 hour. Any
screening that is >95% in either extremity with no more than a 3% absolute difference in
oxygen saturation between the upper and lower extremity would be considered a "pass"
result and screening would end.
Question 7
The nurse should utilize which of the following parameters to select the appropriate sized
blood pressure cuff?
A. 25% greater than the width of the extremity
B. 50% greater than the width of the extremity
C. The same width as the extremity
D. 75% greater than the width of the extremity
CORRECT ANSWER
A. The cuff width should be 25% greater than the width of the extremity. The blood
pressure reading will be falsely elevated if the cuff is too narrow and falsely low if the
cuff is too large.
Question 8
4
